Abstract
IntroductionHIV prevalence among pregnant women in Kenya is high. Furthermore, there is a high risk of maternal mortality, as many women do not give birth with a skilled healthcare provider. Previous research suggests that fears of HIV testing and unwanted disclosure of HIV status may be important barriers to utilizing maternity services. We explored relationships between women’s perceptions of HIV-related stigma and their attitudes and intentions regarding facility-based childbirth.Methods1,777 pregnant women were interviewed at their first antenatal care visit. We included socio-demographic characteristics, stigma scales, HIV knowledge measures, and an 11-item scale measuring health facility birth attitudes (HFBA). HFBA includes items on cost, transport, comfort, interpersonal relations, and services during delivery at a health facility versus at home. A higher mean HFBA score indicates a more positive attitude towards facility-based childbirth. The mean HFBA score was dichotomized at the median and analyses were conducted with this dichotomized HFBA score using mixed effects logit models.ResultsWomen who anticipated HIV-related stigma from their male partner had lower adjusted odds of having positive attitudes about giving birth at the health facility (adjusted OR = .63, 95% CI 0.50–0.78) and less positive attitudes about health facility birth were strongly related to women’s intention to give birth outside a health facility (adjusted OR = 5.56, 95% CI 2.69–11.51).ConclusionsIn this sample of pregnant women in rural Kenya, those who anticipated HIV-related stigma were less likely to have positive attitudes towards facility-based childbirth. Furthermore, negative attitudes about facility-based childbirth were associated with the intention to deliver outside a health facility. Thus, HIV-related stigma reduction efforts might result in more positive attitudes towards facility-based childbirth, and thereby lead to an increased level of skilled birth attendance, and reductions in maternal and infant mortality.
Highlights
HIV prevalence among pregnant women in Kenya is high
HIV-related stigma reduction efforts might result in more positive attitudes towards facility-based childbirth, and thereby lead to an increased level of skilled birth attendance, and reductions in maternal and infant mortality
Setting and Participants The Maternity in Migori and AIDS Stigma (MAMAS) Study was conducted at sites supported by Family AIDS Care and Education Services (FACES), an HIV prevention, care, and treatment program operating in Nyanza Province Kenya
Summary
There is a high risk of maternal mortality, as many women do not give birth with a skilled healthcare provider. Childbirth with a skilled healthcare provider is one of the key strategies recommended for prevention of maternal mortality and morbidity and has been identified as important for enhancing prevention of mother-to-child transmission (PMTCT) of HIV [2]. In Kenya, only 43% of women give birth in a health facility with a skilled healthcare provider [3] and the lifetime risk of maternal mortality is 1 in 38 [4]. Many Kenyan women deliver outside the health facility with the assistance of an untrained traditional birth attendant (TBA). A significant body of research has focused on the identification of factors that might explain why many women deliver outside the health facility globally. Home birth is highly valued in many African cultures and delivering outside the homestead may be a cultural taboo [11,15]
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